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Partial victories for SMMC, Inspectorate in court case

PHILIPSBURG–St. Maarten Medical Center (SMMC) and the Inspectorate of Public Health IVSA both booked partial victories in the court case filed by the hospital against the Inspectorate on August 22, 2016, it emerged Friday.

A Court hearing in this case was held on April 24, 2017. The Judge initially announced that she would pronounce a verdict on May 16, but ultimately a decision was not reached until almost two months later.

In the LAR administrative proceedings, SMMC, represented by attorney-at-law Pieter Soons, had filed objections against two orders with payment of penalties issued by the Inspectorate on March 23, 2016. One concerned the unauthorized employment of medical practitioners at the hospital. The second concerned the hospital’s failure to report all potential calamities at the medical facility within 24 hours.

In the contested decisions, the Inspectorate had attached a maximum penalty of NAf. 75,000 in case SMMC failed to comply with the obligation to administer the oath of new medical practitioners within a period of three months.

The Inspectorate, represented in the procedure by attorney Dana Kweekel, also ordered SMMC to report calamities within 48 hours, or face a maximum penalty of NAf. 200,000.

By letter of January 21, 2016, the Inspectorate had called upon SMMC to cease the employment of two medical doctors. In response, SMMC informed the Inspectorate that one of the mentioned doctors had not been working at SMMC after January 15, 2016, whereas the other was undergoing a work programme “under full supervision” at the Emergency Ward.

A request for a ministerial decision on behalf of one of the medical practitioners was filed with the Minister of Public Health on December 9, 2015. The Court found it proven that for “at least some time” both medical doctors had been working at SMMC in January 2016 without the Minister’s authorisation.

By law, a doctor can only start working at the hospital after ministerial authorisation, and after being put under oath by the Governor.

In the verdict, the Court stated that it could not be said that SMMC had done everything in its power to obtain all the required paperwork for the two practitioners well on time.

In one case, the Court established that SMMC had only started the procedure shortly before commencement of the labour contract. In the second case, the procedure was only started after the doctor’s arrival on St. Maarten.

Therefore, the Court’s decision on the admission of medical practitioners went in the Inspectorate’s favour. The Judge said the Inspectorate had rightfully used its authority to impose penalties, also because the Inspectorate, had granted the hospital a period of three months to administer the oath on new practitioners upon receipt of ministerial approval.

The hospital’s arguments that the procedures were insufficiently “streamlined” were dismissed. SMMC claimed that the procedures to obtain ministerial approval take a very long time, and that only after the minister’s approval the immigration process can be started, before any oath can be administered.

Under the National Ordinance for Health Institutions (LV Zorginstellingen), the hospital is obligated to provide “responsible” care.

“Under the provision of care, falls the obligation to only employ expert and competent doctors, who comply with all requirements to be allowed to work in the hospital,” the Judge stated.

In another letter sent on January 21, 2016, the Inspectorate wrote that “any unexpected or unwanted event occurring during provision of care, treatment or stay of a patient that has led to or will lead to death or severe harm,” should be considered a calamity.

According to the Inspectorate, SMMC had failed in its obligation to report five such calamities to the Inspectorate.

The hospital responded by saying that two of these cases were no calamities, while two had been reported after it had become clear that these were indeed calamities. In one case, SMMC admitted that it concerned a calamity which it had wrongly failed to report.

In the opinion of the Court, the Inspectorate had provided a “clear and workable” definition of the concept of a calamity. The Inspector, however, had failed to provide similar clarity where it concerned the required timeframe in which SMMC has to report such incidents, the Judge stated.

Only in one case could it be ascertained that SMMC had not met the deadline to report the incident, the Court stated. Furthermore, parties were still involved in discussions concerning guidelines in this respect, which led the Judge to the conclusion that no Court decision could be made at this point, and no penalties could be imposed.

For the practice of medicine in violation of the obligations as mentioned in two national ordinances, SMMC was ordered to pay the legal cost of these proceedings, which were set at NAf. 1,550.

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